Regurgitation in infants is the effortless return of gastric contents through the esophagus and out of the mouth. It is a common phenomenon in infants and typically part of normal gastrointestinal development.
GER vs GERD1
- GER (Gastroesophageal Reflux): Physiological in infants; “happy spitters” meet Rome IV criteria, ≥2 regurgitations/day for ≥3 weeks in healthy infants aged 3 weeks–12 months.
- GERD (Gastroesophageal Reflux Disease): More severe symptoms such as excessive crying, back arching, and irritability; may lead to complications.
Prevalence and Contributing Factors
The prevalence of regurgitation in infants under 12 months varies widely, occurring in 80 to 85% of healthy infants2. Several factors can contribute to regurgitation in infants, especially the immature lower esophageal sphincter.
Acid & Non-Acid Reflux
Refluxates can be non-acidic and acidic.
- ~60% of cases are non-acidic but equally uncomfortable.
- Symptoms: regurgitation, coughing, crying3.
Management: The Role of Thickened Feeds for Infants
- First-line: Thickened feeds + parental education & reassurance1.
- Smaller, more frequent feeds recommended.
- Maintain thickened formula up to 6–12 months depending on symptom relapse.
Thickened formulas reduce the frequency and volume of regurgitation by increasing the viscosity of the feed. They also increase the number of days without regurgitation and reduce the symptoms, e.g. crying & irritability.
1. Rosen R., et al., Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN 66: 516–554 (2018).
2. Vandenplas Y., et al., Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. JPGN 61: 531–537 (2015).
3. Salvatore S., & Vandenplas,Y., Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics 110, 972–984 (2002).
Novalac solution
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Novalac solution
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What do guidelines say?
Novalac solution
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